LETTER OF TERMINATION

[DATE]
[GROUP_NAME]
Attn: [GROUP_CONTACT] (if no data, use “Group Benefit Administrator”)
[GRP_ADDR1]
[GRP_CITY], [GRP_STATE] [GRP_ZIP]
Group #: [GROUP_NBR]

Dear [GROUP_CONTACT] (if no data, use “Group Benefit Administrator”),

After attempting to notify you multiple times within your Group’s grace period, we
regret to inform you that your Group’s health insurance coverage with CareConnect has
been terminated as of PAID_THRU_DATE] for failure to pay premium.
As of [GRACE_START_DATE], you and your co-workers no longer have health insurance
coverage with CareConnect. All claims submitted on or after this date for members of
your Group will be denied. If there are any outstanding claims after [PAID_THRU_DATE],
weencourage Group members to notify their providers and arrange for alternative
methods of payment. For details on the Terms and Conditions of your Group’s
agreement with CareConnect, please refer to your Group Contract.
We appreciated your Group’s membership and hope to provide you and your co-workers
with healthier insurance again in the future.

Sincerely,
CareConnect